VAGINISMUS

VAGINISMUS


Vaginismus [vaj-uh-niz-muh s] is considered a disorder of sexual dysfunction.The disorders is an involuntary spasm of the muscles surrounding the vagina. The spasms close the vagina. Vaginismus can cause vaginal penetration during sex is difficult or impossible, and vaginal pain is common during sexual intercourse or an attempted pelvic exam. Vaginismus is also closely related to any of the other forms of dyspareunia in that any type of general sex pain may trigger vaginismus. Most women with vaginismus cannot tolerate sexual intercourse, and some cannot tolerate using tampons. It has several possible causes, including past sexual trauma or abuse, psychological factors, or a history of discomfort with sexual intercourse. Sometimes no cause can be found. 

Vaginismus Involuntary Tightness - In the diagram [1] on the left, the effects of vaginismus are illustrated with the tightening of the pelvic floor muscles and the resulting tightness of the vagina. On the right, the pelvic floor is relaxed and intercourse is possible without pain.

There are two types of vaginismus; primary (i.e. lifelong) and secondary (occurring after a period of normal sexual function). When a woman has never at any time been able to have pain-free intercourse due to vaginismus tightness, her condition is known as primary vaginismus. Vaginismus can also develop later in life, even after many years of pleasurable intercourse.

This type of condition, known as secondary vaginismus, is usually precipitated by a medical condition, traumatic event, childbirth, surgery, or life-change (menopause). Although these women will remember that penetrations used to be fine, they are now faced with painful/impossible intercourse and gynecologic exams. The cause for their secondary vaginismus is the loss of lubrication and elasticity in the vagina, making them feel just as isolated and hopeless as those with primary vaginismus.

Although a woman can easily diagnose her vaginismus, medical evaluation is recommended as the following information is not intended to be used in lieu of proper medical care. Doctors base the diagnosis on symptoms and a subsequent pelvic examination, done as gently as possible. Women are taught how to touch her genital area, gradually moving closer to her vagina and becoming used to touching it without causing pain, and then to insert progressively larger cones. These exercises may enable women to have sexual intercourse without pain.

There are a variety of factors that can contribute to vaginismus. These may be psychological or physiological, and the treatment required can depend on the reason that the woman has developed the condition. As each case is different, an individualized approach to treatment is useful. Treatment involves extensive therapy that combines education, counseling, and behavioral exercises.

Typically, treatment includes relaxation, Kegel exercises (pelvic floor muscle contraction and relaxation) and individual and partner involvement in a series of at-home exercises, including repeated practice with insertion (dilation) training. Each woman moves at her own pace and decides when she is ready for the next step. Pain and discomfort are avoided throughout the treatment.

The other treatment of vaginismus is treating with hypnosis. In general, hypnotherapy tends to focus on overcoming the vaginismus itself, as opposed to resolving any causes or conflicts behind it. Hypnosis is unsurpassed at dealing with unconscious processes. This is why is useful to help sports people excel - their brain can be trained to control their muscles in precisely the right way. Similarly, hypnosis can be used to treat high blood pressure because it relaxes the body like no other method can.

A good news for patient with vaginismus that reported new treatment to use botolinum toxin (botox). Botox is a relatively new treatment for vaginismus, first described in 1997. Ghazizadeh and Nikzad reported on the use of botulinum toxin in the treatment of refractory vaginismus in 24 patients. In this study, Dysport (a type of Botox) 150-400 mIU (Ipsen Ltd, United Kingdom) was used. 23 patients were able to have vaginal examinations one week post procedure showing little or no vaginismus.

If you have pain associated with intercourse or difficulties with successful vaginal penetration, contact your health care provider. When a physician or gynecologist is consulted, involuntary spasm during pelvic examination can confirm the diagnosis of vaginismus, and the physician will rule out any physiological causes for the condition. When psychological causes are suspected, referral should be made to a psychologist or psychiatrist.

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